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Report on National Convention on Quality in Public Health

20th & 21st April 2018

Venue- Auditorium, PGIMER, Dr RML Hospital,

New Delhi

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Programme Overview

Time Session Details

Day 1: Friday, 20th April 2018

9.00 AM-9.30 AM Registration

Session I: Plenary - Health Systems Approach to Quality

9:30 AM – 9:35 AM Aims & Objectives of

Convention

Dr J N Srivastava, Advisor – QI,

NHSRC

9:35 AM-9:45 AM Lessons learnt from Journey of

Quality: NHSRC Experience

Dr Nikhil Prakash, Sr Consultant,

NHSRC

9:45 AM-10:15 AM Managing Quality, Cost & Efficiency

with Volumes: Learning from Aravind

Eye Care System

Dr R Ravindran, Chairman, Aravind

Eyecare System, Madurai

10:15 AM -10:30 AM Family Centered Newborn Care:

Paradigm in Quality of Health Care

Dr Arti Maria, Prof & Head, Dept. of

Neonatology, RML Hospital

10:30 – 11:15 Tea Break & Poster Presentation

Inaugural Function

11.15 AM-11.20 AM Welcome Address Dr Rajani Ved, ED NHSRC

11.20 AM-11.25 AM Address by Superintendent

RML Hospital

Dr VK Tiwari, Superintendent, RML

Hospital

11.25AM – 11.35AM Address by AS&MD NHM Shri Manoj Jhalani, AS&MD NHM

11.35AM – 11.45AM Address by DGHS Dr Promila Gupta, DGHS

11.45 AM-11.50 AM Release of STGs (12 Clinical

Conditions)

Shri Ashwini Kumar Chaubey, Minister

of State for Health & Family Welfare,

GOI

11.50 AM–12.05 PM Address by Chief Guest Shri Ashwini Kumar Chaubey, Minister

of State for Health & Family Welfare,

GOI

12.05 PM–12.55 PM Felicitation of NQAS certified Health

Facilities & State Quality Teams

Shri Ashwini Kumar Chaubey, Minister

of State for Health & Family Welfare,

GOI

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12.55 AM-1.00 PM Vote of Thanks Dr J N Srivastava, Advisor-QI,

NHSRC

1.00 PM-2.00 PM Lunch

Session II: Rapid Improvement in Care around birth: ‘LaQshya’ Chair: Ms

Vandana Gurnani, Joint Secretary (RCH) MoHFW

Co-Chair: Dr Dinesh Baswal, D C I/C MH Division MoHFW

2.00 PM- 2.15 PM Operationalization of Obstetrics ICU

& HDU

Dr Dinesh Baswal, Deputy Commissioner

I/C MH, MOHFW

2.15 PM- 2.30 PM Respectful Maternity Care (RMC) in

Indian Context

Dr Manmeet Kaur, Additional Professor,

School of Public Health PGI

2.30 PM- 2.45 PM Ensuring Neonatal Care in

Labour room & Maternity OT

Prof Vikram Datta, Director Prof,

Department of Neonatology, LHMC

2.45 PM-3.00 PM Partnership with FOGSI for

‘LaQshya’ Roll-out

Dr Jayam Kannan, FOGSI

3.00 PM- 3.15 PM Challenges in Implementing QoC

Efforts

Dr Mrunal Shetye, Bill & Melinda

Gates Foundation

3.15 PM-3.30 PM Discussion

3:30 PM-4.00 PM Tea Break & Evaluation of Posters

Session III: Patient Safety: An Integral Part of

Quality Assurance Chair: Prof JK Das, Director NIHFW

Co-Chair: Dr Inder Prakash, Advisor (PH)

4.00 PM-4.15 PM Patient Safety Framework in

India: Overview

Dr Chhavi Pant Joshi, DADG

4.15 PM-4.30 PM Resetting Priorities for Safer Care Dr Akhil Sangal, CEO, Indian

Confederation for Healthcare Accreditation

4.30 PM-4.45 PM Drug Safety in Health Facilities Dr Y K Gupta, Prof & Head,

Department of Pharmacology AIIMS

4.45 PM-5.00 PM Status of Patient Safety

Education & Training in India

Prof Utsuk Datta NIHFW

5.00 PM-5.15 PM Quality & Safety in UHC Dr Chandrakant Lahariya, WHO Country

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Office

5.15 PM-5.30 PM Discussion & QA

Day 2: Saturday, 21st April 2018

Session IV: Models of Quality of Care

Chair: Dr Phyllida Travis, Director of Health System Development, WHO SEARO (TBC)

9:00 AM-9.15 AM ‘Lean’ as tool for Quality

Improvement

Dr VK Singh, Managing Director,

Innovatiocuris

9:15 AM-9.30 AM NABH Accreditation of Public

Health Facilities

Dr Harish Nadkarni CEO NABH

9:30 AM-9.45 AM POCQI Experience in AIIMS Dr K Aparna Sharma AIIMS

9:45 AM-9.55 AM IHI’s Approach to Health

Quality – Overview

Dr Abha Mehndiratta, IHI

9.55 AM-10.05 AM IHI Implementation Experience

in Telangana

Dr Ajit Sudke, Access Health

10.05 AM-10.15 AM Learnings from ‘Mera-Aspataal’

Implementation

Dr Varun Goyal

Deputy Chief of Party, SAATHII

10.15 AM-10:30 AM STG as a tool for Quality

Assurance

Dr Sangeeta Sharma, Prof & Head,

Department of

Neuropsychopharmacology, IHBAS

10.30 AM-11.00 AM Building Partnerships for Scaling-up of Quality Interventions

Dr T Sundararaman, Dean, School of Health Systems Studies, TISS

11.00 AM – 11.30 AM Tea

Session IV: Learnings from the States Chair: Prof

Vinod Paul, Member Niti Aayog

Co-Chair: Dr Rajani Ved, ED NHSRC

11.30 AM-11.45 AM Supporting State Teams for

Improving ‘Quality of Care’

Ms. Pradipta Kundu, JSS

11.45 AM- 11.55 AM Challenges in Roll-out of Kayakalp

in Jammu & Kashmir

Dr Narinder Bhatial, Jammu &

Kashmir

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11.55 AM- 12.05 PM Sustaining Achievements of

Kayakalp Initiative in Uttar

Pradesh

Dr Archana Verma, UP

12.05 PM- 12.15PM Scaling-up of NQAS

Implementation in Punjab

Dr Parvinder Pal Kaur, Punjab

12.15 PM- 12.25 PM NQAS Implementation in PHCs Dr Balasaheb Sonwane, Maharashtra

12.25 PM- 12.35 PM Implementing NQAS in Urban

Health Facility

Dr. Pradeep Singla, Haryana

12.35 PM- 12.45 PM Monitoring of NQAS Indicators Dr Sandeep Sanyal, West Bengal

12.45 PM- 12.55 PM IT Enabled Performance

Monitoring

Dr JL Meena, Gujarat

12.55 PM- 1.05 PM State level Challenges in NQAS

Implementation

Dr. Amjith Kutty, Kerala

1.05 PM- 1.15 PM Challenges in NQAS

Implementation in NE States

Dr Joy Lyngwa, Meghalaya

1.15 PM-1.30 PM Address by the Chair and Distribution of Best Poster Presentation Awards

1.30PM– 2.15 PM Lunch

2.15 PM–3.15 PM Experience sharing by other States

3:15 PM onward Tea

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National Quality Convention Dated: 20th April to 21st April 2018

National Quality Assurance Program has been launched with aim of improving the quality of

service in public health facilities and program. Program has been well received in by all the

states. The first National Convention on Quality in Public Health was organized in November

2014. Since the first convention in 2014 the program evolved into a national wide quality

movement. Second National Convention on Quality in Public Health was organized on 20th

and 21st April 2018 with the following objectives:

1. To provide a national level platform to share the best practices and problem-solving

ideas for quality improvement in public health facilities and programs.

2. To felicitate the national quality certified facilities and best quality teams

3. To review the progress of implementation of quality assurance program

4. To draft the long-term strategic plan for quality improvement program

5. To discuss the strategy for emerging themes such as Patient safety, Quality in Medical

Colleges and LaQshya.

Day-01

Session I: Plenary-Health Systems Approach to Quality

1. Dr. J.N Srivastava

Advisor-QI, National Health Systems Resource Centre

Dr. J.N Srivastava, extended a warm welcome to all Dias members along with participants

of “National Convention on Quality in Public Health”. He spoke about the National Quality

Assurance Standards (NQAS) Certification process providing the statistics that 91 facilities

have been quality certified. He also briefed that the facilities should perform internal

assessment, identify the gaps and close their procedural gaps within 6 months with the

help of their respective State Quality Assurance Committees with in the State. He concluded

by highlighting the need for sustaining these efforts under quality by yearly surveillance

audit and Operationalization of “Mera Aspatal” in the State.

2. Dr. Nikhil Prakash

Senior Consultant-QI, National Health Systems Resource Centre

Dr. Nikhil Prakash, briefed about the journey of quality in the past few years under NHM and

the learnings from this journey. In 2008-12 ISO Generic QMS Model, in 2013 Operational

Guidelines for Quality Assurance were released. In 2015 Kayakalp Program was introduced

as a stepping stone in quality assurance. Further in 2016, Mera Aspatal and Quality program

in Urban Health Facilities were introduced. Further in this direction, Swachh Swastha

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Sarvatra program was launched with the aim of improving cleanliness, sanitation and

hygiene in the surrounding environment to make India open defecation free country.

Recently LaQshya was evolved in December 2017 with the aim improving quality of care

during the intrapartum and immediate post-partum care. He mentioned 6 Key Learnings

from the journey of Quality Improvement in past years.

1. Quality initiatives can be implemented through vertical programs but inter-sectoral

convergence is required for a common vision.

2. Every problem has a solution, identify the gaps and root cause of the problem, prioritize

them as per the availability of resources and constraint.

3. 80% of the problem are process oriented, focus on them for continuous quality

improvement.

4. Think of last person in the queue- Identify the weakest link and bring them to our level

5. Small is beautiful- Maharashtra getting max awards since they selected PHC’s

6. Be your own lamp, Grow Organic Way- Internalize all the processes within the system so

that all the efforts can be sustained.

He stressed on developing “Systems approach to Quality” meaning some kind of direction or

magnet is required to align all the quality improvement goals. He concluded with quoting

Juran’s Trilogy for quality management which includes quality planning, quality

improvement and quality control as a part of one organic system that is quality

management.

3. Dr. R Ravindran

Chairman, Aravind Eyecare System, Madurai

He spoke about “Managing Quality, Cost & Efficiency with Volumes and Learning from

Aravind Eye Care”. He briefed on the journey of Aravind Eye Care which started with 10

beds and today holds 6 tertiary care centers, 6 Secondary care centres, 6 Outpatient clinics

and 65 Vision Centre’s. All this was accomplished largely by continuous quality

improvement, monitoring and evaluation of ongoing processes which helped assess and

improve the outcomes. He concluded by addressing the need to take ownership and

accountability of the problems to address the barriers that affect the effectiveness of health

services.

4. Dr. R Arti Maria

Professor & Head, Department of Neonatology, RML Hospital

Dr Arti Maria spoke about “Family Centered Newborn Care: Paradigm in Quality of Health

Care”. She briefed on the journey of the model of Patient Centeredness implemented in Dr.

R.M.L Hospital for the past 11 years. In 2007, Dr. R.M.L Hospital newborn care department

was facing issues of incessant alarms, wet babies, misplaced tubes/probes and frequent IV

swellings. To resolve these issues, they engaged the parents and patient attendants as

nursing aides for their own babies for better management. This led them to conceptualize a

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model of family centric care rather than the conventional provider centric model of care.

Audio-visual training tools were developed to standardize this intervention with 4 modules

to capacity build the parents with respect to essential care giving skills, supportive care,

kangaroo mother care and care at home. This brought about net outcome of quality

improvement, improved health outcome and continuum of care through empowering,

encouraging, participative ownership and positive/trustful relationships between care

provider and care seeker.

5. Dr. Rajani Ved

Executive Director, National Health Systems Resource Centre

Dr. Rajani Ved extended a warm welcome to all Dias members and briefed the importance

of Quality of care to achieve the goal of Universal Health Coverage. She emphasized upon

to build the culture of cross learning between states which would help in identifying and

addressing the challenges at the grass root level itself.

This session was followed by welcome address from key dignitaries namely; Dr. VK

Tiwari, Superintendent, RML Hospital, Shri Manoj Jhalani, AS&MD NHM. Following which,

Shri Ashwini Kumar Chaubey, Minister of State for Health and Family Welfare, released

Standard Treatment Guidelines for 12 clinical conditions and an update on National

Quality Assurance Standards (photo is attached as Annexure I). During this session, they

felicitated quality certified Public Health Facilities against National Quality Assurance

Standards (NQAS) along with their respective State Quality teams.

Session II: Rapid Improvement in Care around birth: ‘LaQshya’

Chair: Ms. Vandana Gurnani, Joint Secretary (RCH) MoHFW

Co-Chair: Dr Dinesh Baswal, D C I/C MH Division MoHFW

1. Dr Dinesh Baswal, Deputy Commissioner I/C MH, MOHFW

He briefed about the rationale for establishing Obstetrics ICU & HDU in India. He reflected

upon the that approximately 46% maternal deaths, over 40% stillbirths and 40% neonatal

deaths take place on the day of the delivery. He further explained the reasons for this are

due to inadequacy of Critical care in present set up, overloaded ICUs, non-adherence to

clinical protocols by the service provider at the health facilities. He described about the

following Objectives under LaQshya programme implementation:

i. The Govt of India will support the states in establishing and operationalizing

Obstetric/HDU/Hybrid/ICU in Medical Colleges and District hospitals based on their

needs

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ii. Use standard recording format for already functional and newly operationalized

facilities

iii. Develop IT enable monitoring system for critical maternal cases

He stated that at present nearly 45 public health facilities across the country is running

obstetric ICU/HDUs. In this direction, workshops were organized and state level planning

was done in 28 states. He quoted the required infrastructure, Human resource as per the

availability of bed in Obstetric HDU, Hybrid HBU and ICU. Finally, he emphasized upon the

importance of Capacity Building of Obstetrician, Medical Officer & Staff Nurse in Critical

Care to achieve the desired objectives.

2. Dr Manmeet Kaur

Additional Professor, School of Public Health PGI

Dr Kaur mentioned about the upcoming surge of disrespect & Abuse in Childbirth and it’s

seven domains. Further she explained the findings from Landscape Analysis in India that

highlighted the lack of policies, protocol guidelines curricula pertaining to respectful

maternity care. As per the study, lack of awareness about their right to respectful care,

non-utilization of health services due to disrespect and abuse and lastly lack of formal

research is on this subject are the poor deterrent of maternal services. She mentioned the

methodology of the Study, study area, and about study population under landscape

analysis. She talked about the Physical abuse, non-dignified care, non-consented care,

non-confidential care, discrimination based on specific attributes, detention in facilities,

abandonment or denial of care are barrier to pregnant women and their families accessing

skilled care. Dr Kaur also gave suggestion to ensure RMC by improving knowledge of

women and families on their rights. She concluded by saying we have to work together

with service providers and help them in improving their behavior and services.

3. Prof Vikram Datta

Director Prof, Department of Neonatology, LHMC

He introduced by mentioning the global challenges in ensuring Neonatal Care in Labour

room & Maternity Operation Theatre. The provision of effective care for all women and

babies at the time of birth in facilities would prevent an estimated 1.3 million deaths

annually by 2020. He mentioned about the challenges faced in India including key

interventions having scope for improvement like early initiation of breastfeeding, exclusive

breastfeeding and postnatal visit for baby. He mentioned about the Neonatal LaQshya

targets (Short, Intermediate & Long term). He highlighted that optimal resources and

manpower provision, Capacity building, Skill enhancement, incentivization, monitoring,

adherence to NQAS, adoption of Quality Improvement strategies are the key factors affecting

the Neonatal care in Labour Room & Maternal OT like. He briefed upon reduction of

neonatal hypothermia at admission in his department and shared the results which shows

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89.7% reduction of moderate hypothermia and 55% reduction in deaths per 1000 patient

days. Main focus is on care around the birth practices. He described process improvement in

Labour room and Maternal OT are vital for ensuring optimal maternal and neonatal

outcomes. He concluded by saying the need of the hour is to effectively incorporate QI

strategies across the Labour Room and Maternal OT to promote compliance and sustenance.

4. Dr. Jayam Kannan

FOGSI

Her topic for the presentation was on “Partnership with FOGSI for LaQshya roll-out”. She

appreciated the efforts of National health Mission (NHM) in increasing the institutional

deliveries but also brought up the key question whether this has resulted equally in the

improvement of maternal and newborn healthcare. She narrated the state of 46%

maternal death, 40% still birth and 40% neonatal death occurring on the day of delivery in

India. This emphasized the need of adhering with the clinical procedure and protocols to

improve the maternal and newborn health services. She briefed on the journey of FOGSI,

its affiliation with JHPIEGO and role of ‘Manyata’ program in improving quality maternal

in India. She concluded with a request for collaborative action to support and achieve the

objectives of LaQshya program.

5. Dr. Mrunal Shetye

Bill and Melinda Gates Foundation

He spoke about the “Challenges in Implementing Quality of Care efforts”. He described the

historical evolution of Quality of care since 1854 where there were numerous cases of

cholera and diarrhoea. A group of nurses led by Florence Nightingale, took certain steps

(such as keeping the patient beds 3 feet apart to reduce overcrowding, removed horses

and created separate stables etc.) which in turn reduced the mortality from 42.7% to 2.2%

in 6 months. He further pointed that there have been certain similar tipping points in

history where quality improvement efforts had been taken and further need to be carried

on. One such program namely; Janani Suraksha Yojana was launched in 2015 pushing for

more institutional deliveries but by simply commiserating with the increase in

institutional deliveries we would not be able to bend the curve on maternal and infant

mortality to the aspired levels. He further explains that there is a need to focus on quality

as well as quantity in terms of strengthening the number of public facilities to improve the

quality of care. It needs to be identified whether the barriers are access related or due to

perceived benefits. He believes there is a need to identify the scope of vertical integration

of efforts to bring together the primary, secondary and tertiary level facilities to ensure

seamless continuum of care. He further focused on identifying the motivational factors

that lead to performance because quality is not a onetime effort, it is a continuum of

efforts that need to be sustained. He emphasized on strengthening the referral linkages

and shared his experience on conducting a study in Uttar Pradesh whose results showed

that nurse mentoring is an important factor in bringing improvement changes provided

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the facility’s staff is highly motivated. He emphasized on the health system’s strengthening

including designing of dashboard to improve accountability and governance.

The Session was concluded with felicitation of all the speakers and dignitaries at the dais

followed by evaluation of posters presentation and tea break.

Session III: Patient Safety- An integral part of Quality Assurance

Chair: Prof JK Das, Director NIHFW

Co-Chair: Dr Inder Prakash, advisor (PH)

1. Dr. Chhavi Pant Joshi

DADG

She presented on “overview of the Patient Safety Framework in India”. She shared her

experiences of her first day at medical school wherein the principal welcomes every

student with an inaugural lecture on patient safety emphasizing on the famous

Hippocratic oath of “Do no harm” and essentially focused on importance of adhering to

medical ethics and etiquettes. But somewhere down the line professionals tend to err and

mistakes are committed due to several reasons. She reverberates that with initiatives like

Kayakalp, Swacch Bharat Abhiyan etc. that are inputs driven, now there is a need to move

towards process-oriented approach for a critical outcome in healthcare that is patient

safety. Taking cognizance of this, the Nation’s Patient Safety Framework was developed by

an expert group of the Directorate in 2018. She explained that the framework draws from

WHO regional strategy which is based upon six pillars of patient safety implementation.

The idea behind this framework is better expression of patient safety among all the

existing interventions in healthcare working in both public and private sector, rather than

creating a separate vertical doom of patient safety in silo. She highlighted the contours of

the framework inclusive of a National level steering committee as a central coordinating

mechanism for Patient Safety. She briefed about the mechanisms of the framework and its

strategic objectives along with the accountable nodal agencies/authorities.

2. Dr. Akhil Sangal

CEO, Indian Confederation for Healthcare Accreditation

He addressed the need for “Resetting Priorities for safer care”. He spoke that health care

excellence stands on the pillars of trust resulting from communication, collaboration and

coordination and rests upon foundation of values and culture. He described the various

challenges of safer healthcare. He further points out that if Quality is conformance to

standards, Excellence results from the willingness to conform and is a much larger

domain. He shared his experiences of United Kingdom which led to the identification of

existence of a huge “Know-Do” gap. Despite the knowledge and recognition of magnitude

and costs of unsafe healthcare we are not able to cut it down. To answer this, he stressed

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upon the fact that can only a safe provider provide safe care. He spoke about the myths

and controversies surrounding the scenario wherein he talks about the need for data

sanctity and a culture of reporting rather than complaining. He suggests that less data is

more useful rather than more data which leads to nowhere. He discussed on the missed

issues viz inappropriate care, engagement of clinicians with the patients, lack of trust and

culture of patient safety. He brought in focus about the WHO medical curriculum which

emphasize about the building a safety culture, communication and collaborative

teamwork along with reinforced behavior to change attitude. Furthermore, he suggests

that the solutions lie in the basics by building trust and creating a culture of transparency.

He also emphasizes that rewards, recognitions and solutions based on approach are

essential actions to improve upon. He concluded with the carry home summary “Build

trust through transparency in transactions, build inter-linkages and focus on process.

Knowing is not enough, we should apply and work upon the willingness to do”

3. Dr. Y.K Gupta

Professor & Head, Department of Pharmacology, AIIMS

He mentioned about key challenges of “Drug Safety in Health Facilities”. He emphasized on

the application of principles of efficacy and safety during the development of new drugs

before conducting trials to ensure reasonable certainty that the drug is safe. He explains

that a constant vigilance of adverse events is required even to monitor the existing

drugs/vaccines and also every country needs to conduct its risk benefit assessment to

continue/ban a certain drug. Therefore, the Pharmacovigilance program was launched in

2010 by AIIMS in India with 10 centres which has now expanded to 250 centres across the

nation. The MCI has made it mandatory for reporting of adverse drug reactions and that

each medical college must have a Pharmacovigilance unit for licensing it. He further

explains the importance of risk assessment for management and evidence-based decision

making. He also highlighted the issue of increase in number of deaths due to illegible

prescriptions rendering to administration of wrong drugs to patients. He concludes by

describing the reasons for therapeutic failures and emerging issues of Antimicrobial

Resistance with an upsurge use of antibiotics and suggested that these events should not

lead to the conclusion that the drug is not functioning at all.

4. Prof. Utsuk Datta

NIHFW

He presented on topic namely “Status of Patient Safety Education and Training in India”.

He emphasized that strengthening of patient safety is critical to an effective, efficient and

quality healthcare delivery and it depends on safe practices by the healthcare providers

but we shall not ignore other factors such as huge load of patients at different levels of

public health facilities in India. On the basis of a study conducted, he explained that the

evaluation of healthcare provider in the existing education curriculum should have

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components of patient safety along with their capacity building in this domain through

their training need assessment pertaining to patient safety. Based on this study, the

recommendations included bringing about awareness among teaching faculties, formation

of core group of experts to design and develop a comprehensive curriculum for integrating

the patient safety concept in the existing education curriculum, conduction of regular

CME’s/induction trainings, on site and in-service job trainings/supportive supervision.

Also, an explicit integration of patient safety concept as a whole in healthcare at all levels

is required with periodic assessment of knowledge and skills.

5. Dr. Chandrakant Lahariya

WHO, Country Office

In his presentation, he spoke about “Quality and Safety in Universal Health Coverage

(UHC)”. UHC aims that all individuals and communities receive the quality health services

they need without suffering financial hardship. It is defined by three dimensions namely;

coverage of additional population, provision of additional services and financial

protection. He demystified quality of health services into six dimensions, and patient

safety was one of them which has further components. He emphasized that merely by

making health services accessible does not ensure they will be utilized and effective.

Research shows that demand for health services rises with the improvement in quality. He

further accentuates the need for attention that even in well-developed and resourced

health systems, quality remains a concern. Economic benefits of improving quality of care

are huge while not improving quality tends to be expensive in the long run. He

rationalized the importance of quality of care in achieving UHC and improving clinical

outcomes. Furthermore, he suggested to strengthen the policy and strategy development,

health service provision and engagement of community/service users for achieving

quality improvement. He described various efforts of WHO in these areas and highlighted

an example of WHO study on “Injection Safety Project” in Punjab that recommends use of

“reuse prevention syringes” instead of “auto disable syringes” which shall lead to prevent

and reduce healthcare infections. He summarized by saying that for achieving

improvement in quality, a balanced approach of policy, implementation and community

engagement is needed and all potential opportunities from ongoing initiatives need to be

utilized.

All the session was followed by questions answer round followed by a call for the day.

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Day-02

As we move to the next day of National Convention on Quality in Public Health. The first

session for the day was on Models of Quality of Care chaired by Dr Phyllida Travis, Director

of Health System Development, WHO SEARO and Dr Rajani Ved, Executive director, National

Health Systems Resource Centre (NHSRC) as a co-chair and discusser.

1. Dr Vivek Singh, Managing Director, Innovatiocuris,

He briefed about ‘Lean’ as a tool for Quality Improvement. He highlighted that any quality

health care tools have two aim, one is to reduce the health care delivery cost and other is to

maintain the quality. He gave an over view of various quality models available. He said that

the main focus of lean is to cut down the wastes. The main focus of any quality improvement

tool will be based on 8 quality management principles that are given by ISO. He highlighted

the application of lean at various points of Health care delivery right from the planning or

designing of the hospital to efficient service delivery at laboratories, emergency department,

OPD, Operation Theatre, Pharmacy etc. He highlighted the concept of three P’s that is pain of

the patients, payers and providers. He cited an example of value map streaming done at

Narayana Hirudalaya Hospital for reducing non-value adding activities and thereby reduced

costs and improve quality. He concluded saying that effective implementation of lean can

show rapid improvement in health care facility.

2. Dr Harish Nadkarni, CEO NABH

He discussed about NABH accreditation of public health facilities. During the talk he

mentioned that at present 15 district hospitals which covers 10,000 beds are NABH

accredited and pointed out that timeline and resource crunch are the major difference in

achieving the NABH accreditation in public and private hospitals. Lack of expertise and

support from all the departments are the major barriers for an organization to get

accreditation. Maintaining enthusiasm throughout the course of the project and also during

follow up is an important aspect for its success. He concluded his talk by saying that

involvement of the top and executive management is also crucial to implement any project

at Central, State and local level.

3. Dr K Aparna Sharma AIIMS

She presented on the topic “POCQI experience in AIIMS”. She talked about the presumption

that quality is for managers and clinicians provide health care because they have more

patient interactions and have to face the consequences. She emphasized that quality

problems occur typically not because of failure of goodwill, knowledge, effort or resources

devoted to health care, but because of fundamental short comings in the way care is

delivered. She highlighted the salient features on point of care quality care. She pointed out

the major barrier is the negative attitude of the clinicians. She finally concluded by

emphasizing about the 4-step approach of POCQI and measures they have taken up to

improve quality at AIIMS by conducting various trainings, workshops and projects.

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4. Dr Abha Mehndiratta, IHI

IHI’s Approach to Health Quality

By citing her experiences working with government hospitals of Bihar. She briefed about the

implementation of four key interventions suggested by Edward Deming to improve the

quality of a district hospital. They focused on 4 key areas; Appreciation of a system,

Psychology, understanding variation and Theory of knowledge. She said that despite of

having many barriers like insufficient infrastructure, manpower etc. an engaging leadership

helped in overcoming them. She emphasized that having an open conversation between the

administrators and front-line workers will encourage them to work towards quality

improvement. From her experiences in Bihar, she pointed out the challenges they faced in

understanding the data as the front-line workers were unable to maintain the records

properly. She briefed about a recent project taken up by the government where they have

identified ten district hospitals to achieve positive clinical outcomes. In order to achieve

this, they are engaging with leadership to resolve problems around inputs, strengthening

the data system, providing person centered care, building capability within the system. She

concluded that team work is the major factor for any project.

5. Dr Ajit Sudke, Access Health

IHI Implementation Experience in Telangana.

His main topic of discussion was about the project “Safe care Saving lives” which focused on

reducing neonatal mortality through quality improvement. As part of the project in 2014, 25

hospitals across private and public sector empaneled with Aarogya Sri health care trust to

improve outcomes for newborns. Andhra Pradesh and Telangana were chosen for the

project because they reported more neonatal and maternal death. The uniqueness of the

project is that it is linked to public health insurance scheme. The key drivers of the program

are to provide reliable care, to prevent birth asphyxia, newborn sepsis, complications of

prematurity. They have identified 17 interventions to achieve them, includes process

mapping, root cause analysis, identification of bottle necks, facilitation of removal of bottle

necks and addressing root causes. Other interventions include regular audits and review of

results. As part of the project they have developed an IT Platform for effective data

management and the results were highly satisfactory.

6. Dr Varun Goyal Deputy Chief of Party, SAATHII

Learning’s from ‘Mera-Aspataal’ Implementation

Dr Varun gave an overview on Mera-aspataal which is a multi-channel approach to capture

patient feedback using SMS, OBD, Mobile app, web portal. It covers 25 states and 1000 plus

health facilities. The application has been designed to capture user friendly unbiased

feedback by overcoming the shortcomings like low proportion of valid phone numbers, lack

of stakeholder orientation, etc. It captures data across the nation. Four key parameters

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identified for Mera Aspataal (MA) application which includes overcrowding and long

waiting time, staff behavior, cleanliness, informal payment. After implementation of MA

district hospitals in Rajasthan, Gujarat and Tamil Nadu, they have shown improvement in

their patient satisfaction. He concluded by saying that facilities specific parameters and

timelines should be set up in order to perform better services. He emphasized that

integration of facilities with MA application will also help them in getting NQAS and NABH

accreditation. He requested the states to use the IEC material available on the MA dash

board to sensitize their stake holder and to cooperate with the quality improvement teams

of the hospital for better results.

7. Dr T Sundararaman, Dean, School of Health Systems Studies, TISS

Building Partnerships for Scaling-up of Quality Interventions

He initiated the talk speaking about his experience and journey in the quality assurance

program and pointed out that though 91 facilities have been NQAS certified the

denominator is huge with around 35000 facilities and it is an issue of concern. In order to

cover maximum of these facilities within 5 years the major step is capacity building which is

only possible by formation of a strong quality team. He said that a huge leap from 20 District

Hospitals to 700 District Hospitals can be reached only through partnerships.

He specified about partnerships with private commercial quality management and also

taking up medical colleges as a center of excellence. Select NQAS certified district hospitals

and make them as model to bring others (public health facilities) on board. The other set of

partners can be academic institutions that provide hospital care management programs.

Civil society organizations can be used to advocate and campaign quality health care service

as a human right. He highlighted that the major difference between NQAS and other quality

certifications is that it includes patient rights. Rogi Kalyan Samiti can also play crucial role in

partnerships. Development of mid-level health care provider as quality control cadre is the

other major aspect that’s needs to be addressed for scaling up the quality interventions

This technical session was followed by another session namely; Learnings from the States

chaired by Professor Vinod Paul, Member Niti Aayog and Co-chaired by Dr Rajani Ved, ED

NHSRC. During this session respective State representative shared their key challenges and

strategies implemented by them to improve the health outcomes at their public health

facilities by applying the principles of Quality Assurance and Quality Control for Continuous

Quality Improvement. List of which is mentioned below:

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S. No State Representative Topic 1. Narinder Bhatial, Jammu &

Kashmir Challenges in Roll-out of Kayakalp in Jammu and Kashmir

2. Dr Archana Verma, Uttar Pradesh

Sustaining Achievements of Kayakalp initiative in Uttar Pradesh

3. Dr Parvinder Pal Kaur, Punjab Scaling-up of NQAS implementation in Punjab 4. Dr Balasaheb Sonwane,

Maharashtra NQAS implementation in PHCs

5. Dr Pradeep Singla, Haryana Implementing NQAS in Urban Health Facility 6. Dr Sandeep Sanyal, West Bengal Monitoring of NQAS indicators 7. Dr J L Meena, Gujarat IT enabled performance monitoring 8. Dr Amjith Kutty, Kerala State level Challenges in NQAS implementation 9. Dr Joy Lyngwa, Meghalaya Challenges in NQAS implementation in NE States

This was followed by prize distribution for best poster presentation awards and closing

address by the Chair.

Annexure I